Gonorrhea is one of the most common sexually transmitted infections (STIs). Also called “the clap” and “the drip”, it’s a bacterial infection that’s caused by the Neisseria gonorrhoeae bacterium and is believed to have been around since the biblical times.

As of 2012, the World Health Organization (WHO) estimates that gonorrhea affects 0.6 percent of men and 0.8 percent of women around the world and that around 88 million new cases occur every year.

Gonorrhea is easily treatable, although it can be fatal when left untreated. It caused around 2,300 deaths in 1990, which increased to around 3,200 deaths in 2013 and decreased to around 700 deaths in 2015.

Transmission

The Neisseria gonorrhoeae bacteria are spread through semen, pre-ejaculate, and vaginal fluids as well as through the mucus membranes in the anus and rectum. Because of this, it can be transmitted when an infected person has vaginal and anal intercourse with another person.

The bacteria can also survive in the mucus membranes in the throat and can, therefore, be transmitted when someone who has oral gonorrhea performs oral sex on another person.

While Neisseria gonorrhoeae can’t survive for long outside the body, you can still acquire it simply by touching another person’s body part that has been infected with the bacteria. If you touch the vagina, penis, anus, or throat of a patient with gonorrhea, the bacteria can transfer to the body part that you used to initiate the contact.

For instance, if you touch an infected area with your finger then use the finger to rub your eye, there’s a chance that you’ll develop a gonorrheal infection in your eye.

Women who have gonorrhea and are pregnant can pass the infection to their baby if they opt to have a vaginal delivery. Because of this, it’s important for pregnant women to be tested for gonorrhea during their first pre-natal check-up; this way, they can receive the appropriate treatment if they do have the infection.

Gonorrhea is not transferred to babies who are born through Caesarian section since they don’t pass through the vagina.

Symptoms

The incubation period of Neisseria gonorrhoeae is around two to 14 days, and symptoms typically appear four to six days after the patient is infected. It’s important to note, though, that many people who get infected with gonorrhea don’t experience any signs and symptoms.

This makes the disease difficult to identify and allows it to easily spread from one person to another. Since patients without symptoms assume they’re healthy, they can continue to have intercourse with their partners — without knowing that they’re actually spreading the bacteria.

Many women with gonorrhea experience mild symptoms or have symptoms that are similar to other infections (such as vaginal yeast). As a result, some choose to ignore the symptoms, while others self-medicate but take the wrong kind of medications.

Women with gonorrhea might notice vaginal bleeding in between their periods as well as abnormal vaginal discharge that is either bloody or yellowish and watery or creamy in texture.

They might also notice lower abdominal pain as well as pain when urinating or engaging in vaginal sex. Other symptoms include fever, heavier periods, and frequent urination.

Men with gonorrhea might also notice an abnormal discharge from their penis, which can be white, beige, yellow, or greenish in color and resembles the consistency of pus. The opening of the penis might develop swelling and redness, while the testicles might be painful and swollen.

Men might also notice a painful or burning sensation when urinating as well as greater frequency of urination.

Men and women who engage in anal sex can get a gonorrheal infection in their anus or rectum. Those with anal gonorrhea might notice a discharge from the anus, itching around the anal area or even inside the anus, and a painful sensation when defecating, although it’s possible for patients not to experience any signs and symptoms.

Those who develop a gonorrheal infection in the throat also rarely experience symptoms; if symptoms do manifest, they’re usually in the form of a sore throat.

Complications

If left untreated, gonorrhea can cause lasting damage to reproductive organs. Women can develop pelvic inflammatory disease (which affects the uterus and Fallopian tubes) as well as chronic pain or infertility. If they do get pregnant, there’s a chance that they’ll have an ectopic pregnancy.

Men, on the other hand, can develop epididymitis or the inflammation of the epididymis (the tube that carries sperm from the testicles).

Neisseria gonorrhoeae can also enter the bloodstream and travel to the joints (where it would cause pain and swelling) or the skin (where it would cause lesions to develop). It can also travel to the heart or the spinal column, resulting to endocarditis or meningitis, respectively. However, these rarely happen and are often found in people with suppressed immune systems.

Treatment

Gonorrhea is usually treated with the antibiotic ceftriaxone, which is usually partnered with either doxycycline or azithromycin. However, in the United States, the Centers for Disease Control and Prevention (CDC) recommends only the combination of ceftriaxone and azithromycin.

Neisseria gonorrhoeae is resistant to penicillin, tetracycline, and quinolone, so these medications should not be given to patients with gonorrhea.

Prevention

The only way to completely avoid getting gonorrhea is to not have sexual intercourse. However, you can significantly reduce your chances of getting infected by being in a long-term, monogamous sexual relationship. Using condoms, dental dams, and other barriers can also help limit the spread of bacteria.

If you’re entering a new sexual relationship, have yourself and your partner tested to ensure that both of you are free from gonorrhea. You should also make it a point to get regular screenings (at least once a year) to monitor your sexual health.